<?php require_once "inc.php" ?>
<!DOCTYPE HTML PUBLIC  "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">

<head>
<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1">
<!-- page title -->
<title>Saviance</title>
<link rel="stylesheet" href="images/jquery.tabs.css" type="text/css">
</head>
<body id="faculty_attendace">
<div id="wrapper-admin">
  <?php require_once "header-admin.inc.php"?>
  <!-- header end -->
  <!-- content start -->
  
  <div id="body-wrapper">
    <!-- BREADCRUMB NAVIGATION -->
	<?php //require_once "breadcrum.inc.php"?>
    <div class="admin_container">
      <div class="clear">
        <div id="content2">
          <!--Dont Remove this commented code-->
          <!--<div class="left_menu">
        <div id="primary" class="clear-block">  </div>
              </div>-->
          <!--END DONT REMOVE COMMENT-->
          <div style="" id="main">
            <!--<div id="sidebar-wrapper">-->
            <div class="top-corners">
              <div class="bottom-corners">
                <?php require_once "left_lead_management.inc.php"?>
                <!-- /sidebar-left -->
                <div id="main_content">
                  <div id="">
				  <div class="active-scaffold active-scaffold-as_admission__applicants admission/applicants-view default-theme" id="as_admission__applicants-active-scaffold">
  				  <div class="active-scaffold-header">
				  <div class="actions">
				  <a position="top" id="as_admission__applicants-import--link" class="import action" href="#">
				    <label>
				    <input type="submit" name="Submit" value="Import file form Excel" />
				    </label>
				    </a>           </div>
					<h3>Record New Lead</h3>
					
					<form>
					<table border="0" cellspacing="0" cellpadding="0" width="100%" class="list_table_2">
<tr>
  <td width="21%" style="border-top: 1px solid #C5DBF7">Date Created* : </td>
  <td width="79%" style="border-top: 1px solid #C5DBF7">12/12/2011</td>
</tr>
<tr>
  <td>First Name* : </td>
  <td><input type="text" name="first_name" value="" maxlength="200" /></td>
</tr>
<tr>
  <td>Last Name* : </td>
  <td><input type="text" name="last_name" value="" maxlength="200" /></td>
</tr>
<tr>
  <td>Address1 : </td>
  <td><input type="text" name="address1" value="" maxlength="200" /></td>
</tr>
<tr>
<td>Address2 : </td>
<td><input type="text" name="address2" value="" maxlength="200" /></td>
</tr>
<tr>
  <td>City : </td>
  <td><input type="text" name="city" value="" maxlength="200" /></td>
</tr>
<tr>
  <td>State : </td>
  <td><input type="text" name="state" value="" maxlength="200" /></td>
</tr>
<tr>
  <td>Country : </td>
  <td><select>
  <option value ="sydney">Sydney</option>
  <option value ="melbourne">Melbourne</option>
  <option value ="cromwell">Cromwell</option>
  <option value ="queenstown">Queenstown</option>
  <option value ="usa">USA</option>
  <option value ="uk">UK</option>
  <option value ="india" selected="selected">India</option>
    </select></td>
</tr>
<tr>
  <td>Pin Code : </td>
  <td><input name="pinecode" type="text" id="pinecode" maxlength="200" /></td>
</tr>
<tr>
  <td>Home Phone : </td>
  <td><input type="text" name="homephone" value="" maxlength="200" /></td>
</tr>
<tr>
  <td>Mobile No. : </td>
  <td><input type="text" name="mobileno" value="" maxlength="200" /></td>
</tr>
<tr>
  <td>E-mail ID : </td>
  <td><input type="text" name="emailid" value="" maxlength="200" /></td>
</tr>
<tr>
  <td>	How did you hear about us : </td>
  <td><select>
  <option value ="newspaper" selected="selected">Newspaper</option>
  <option value ="magazine">Magazine</option>
  <option value ="billboard">Billboard</option>
  <option value ="onlineadvertisement">Online Advertisement</option>
  <option value ="friendsorfamily">Friends/Family</option>
  <option value ="others">Others</option>
    </select></td>
</tr>
<tr>
  <td>Interested Area : </td>
  <td><textarea rows="3" cols="30" name="textarea"></textarea></td>
</tr>
<tr>
  <td>Status : </td>
  <td><input type="radio" name="lunch" value="pasta" /> Registered  <input type="radio" name="lunch" value="pasta" /> Un-Registered
</td>
</tr>

<tr>
<td>Comments:</td>
<td>
<textarea rows="3" cols="30" name="comments"></textarea></td>
</tr>
<tr><td> </td>
<td>
<input type="submit" value="Submit" /></td>
</tr>
</table>
					</form>
                  </div>
                </div>
                <!-- /content -->
                <span class="clear"></span> </div>
            </div>
            <!--</div>-->
            <!-- /sidebar_wrapper -->
          </div>
        </div>
      </div>
      <!-- end three column -->
    </div>
  </div>
  
  <!-- content end -->
  <!-- footer start -->
 <?php require_once "footer.inc.php"; ?>
  <!-- footer end -->
</div>
</body>
</html>